The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node.
This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival.
The 5-year survival of patients with positive level 13a with 1–3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P < .05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients.
A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Gallbladder.in: Amin MB Edge S Greene F Byrd DR Brookland RK Washington MK AJCC cancer staging manual. 8th ed. Springer, New York2017: 303-309
- Identification of the regional lymphatic system of the gallbladder by vital staining.Br J Surg. 1992; 79: 659-662
- Regional lymphadenectomy for gallbladder cancer: rational extent, technical details and patient outcomes.World J Gastroenterol. 2012; 18: 2775-2783
- Relevance of dissection of the posterior superior pancreaticoduodenal lymph nodes in gallbladder carcinoma.Ann Surg Oncol. 2017; 24: 2474-2481
- Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using western and Japanese classification systems.World J Surg. 2000; 24: 1271-1276
Behari A, Kapoor VK. Gall bladder cancer: is the stage set? Yet! J Gastrointest Cancer Stromal Tumor 2016;1:107.
- Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment.Ann Surg. 2011; 254: 320-325
- Surgical approaches to advanced gall bladder cancer: a 40 year single institution study of prognostic factors and resectability.Ann Surg Oncol. 2014; 21: 4308-4316
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- The role of lymph node dissection in the treatment of gallbladder carcinoma.Cancer. 1997; 79: 892-899
- Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma.J Hepatobiliary Pancreat Surg. 2004; 11: 45-49
- Biliary tract cancer registry in Japan from 2008 to 2013.J Hepatobiliary Pancreat Sci. 2016; 23: 149-157
- Extended cholecystectomy for carcinoma of the gall bladder.World J Surg. 1995; 19: 758-763
- Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer.Eur J Surg Oncol. 2004; 30: 842-846
- Significance of extensive surgery including resection of the pancreas head for the treatment of gallbladder cancer—from the perspective of mode of lymph node involvement and surgical outcome.World J Surg. 2006; 30: 36-42
- Surgery for gall bladder cancer in the US: a need for greater lymph node clearance.J Gastrointest Oncol. 2015; 6: 452-458
- Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma.Br J Surg. 2000; 87: 418-422
- Radiological downstaging with neoadjuvant therapy in unresectable gall bladder cancer cases.Asian Pac J Cancer Prev. 2016; 17: 2137-2140
- Resection after neoadjuvant chemotherapy in advanced carcinoma of the gall bladder: a retrospective study.Indian J Surg Oncol. 2015; 6: 16-19
- Systemic chemotherapy combined with resection for locally advanced gallbladder carcinoma.J Am Coll Surg. 2017; 224: 906-916
Nishio H, Nagino M, Ebata T, Yokoyama Y, Igami T, Nimura Y. Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications? J Hepatobiliary Pancreat Surg 2007;14:351-7.
- Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma.Ann Surg Oncol. 2010; 17: 1831-1840
Published online: October 19, 2018
Accepted: September 14, 2018
Received in revised form: September 14, 2018
Received: May 19, 2018
© 2018 Elsevier Inc. All rights reserved.